Cost Comparison of Arthroscopic Rotator Cuff Repair With Arthroscopic Versus Open Biceps Tenodesis

Purpose: To use a nationwide database to determine differences in cost between patients who underwent arthroscopic rotator cuff tear with open versus arthroscopic biceps tenodesis.

Methods: The 2014 State Ambulatory Surgical and Services Databases from six US states was utilized. All cases with CPT codes 29827 (arthroscopic rotator cuff repair [RCR]) and either 23430 (tenodesis of long tendon of biceps) or 29828 (arthroscopic biceps tenodesis) were selected. Cases that included both 23430 and 29828 were excluded, as were those missing demographic data. Generalized linear models were used to model costs based on the surgical and patient variables that were significant in the initial bivariate analysis (P < .05).

Results: 3,635 RCR and tenodesis (BT) cases were identified. There were 2,847 (78.3%) with arthroscopic BT, and 788 (21.7%) with open BT. Patients undergoing arthroscopic BT were 3.1 years older than patients undergoing open BT (P < .001). For arthroscopic BT, 39.2% of the cases were women compared to 22.6% of the open cases (P < .001). For operative variables, arthroscopic BT required 9 fewer minutes in the OR than open cases (P = .002). Concomitant distal clavicle resection was performed in 35.5% of arthroscopic biceps tenodesis cases compared to 29.8% of open cases (P = .004). While controlling for other significant factors, open BT was associated with $5,542 lower costs than arthroscopic BT in the setting of RCR (P < .001). In either case, concomitant subacromial decompression added $10,669 (P < .001), and distal clavicle resection added $3,210 (P < .001). High volume surgical facilities were associated with $4,107 lower costs (P < .001).

Conclusions: In a large series of patients undergoing arthroscopic RCR with open versus arthroscopic BT, open BT was associated with $5,542 lower costs than arthroscopic. Given that both techniques have been shown to be similarly effective in long term follow-up, surgeons should be aware of opportunities for cost saving, particularly with advent of bundled surgical reimbursements.

Keywords: arthroscopy; biceps tenodesis; cost analysis; rotator cuff.